Digestive and Liver Disease最新文献

Background: Studies from northern Europe indicate that patients with primary sclerosing cholangitis (PSC) are predominantly males and often have ulcerative colitis (UC) and increased risk of colorectal cancer (CRC).

Aim: To evaluate the epidemiological and clinical features and natural history of PSC in Greece, a southern European country.

Methods: In the HERACLIS-PSC study, consecutive patients with PSC-IBD followed at Greek inflammatory bowel disease (IBD) centers were included and compared to data from consecutive patients with PSC-only followed at a Greek liver center.

Results: Among PSC-IBD patients (n=112, males:56%), 62.5% had UC (pancolitis:76%), 35.7% Crohn's disease and 1.8% indeterminate colitis. PSC was diagnosed at a younger age in PSC-IBD than PSC-only patients (n=39; males:54%) (32±15 vs 40±15 years; p=0.007), while the two groups did not differ significantly in gender, extrahepatic bile duct involvement, or development of cirrhosis, cholangiocarcinoma or CRC, although CRC occurred only in PSC-IBD (n=8). Transplant-free survival was higher in PSC-IBD than PSC-only (5-/10-year:95%/87% vs 85%/77%; p=0.021), while older age at PSC diagnosis and cirrhosis development were independently associated with lower transplant-free survival.

Conclusion: In Greece, PSC-IBD patients are usually males with UC, in whom PSC is diagnosed at a younger age demonstrating better transplant-free survival, compared to PSC-only.

Background: Prospective evidence on Endoscopic Ultrasound-guided drainage (EUS-FCD) for Post-surgical Fluid Collections (PS-FCs) is lacking, and differences from Post-pancreatitis collections (PP-FCs) remain undefined.

Methods: All consecutive patients undergoing EUS-FCD with Lumen Apposing Metal Stents (LAMSs) or Double-Pigtail Plastic Stents (DPPSs) between 2020-2024 were included in a prospective registry (PROTECT, ClinicalTrials.gov NCT04813055), with scheduled follow-up exploring efficacy and safety outcomes.

Results: At baseline, PS-FCs (N=41) versus PP-FCs (N=45) occupied fewer abdominal quadrants (p=0.04), showed reduced necrotic content (none/≤30% in 68% vs 42%, p<0.05), thus less frequently belonging to the high-risk Quadrant-Necrosis-Infection classifier (24% vs 49%, p=0.02). PS-FCs more frequently presented infection as the drainage indication (68% vs 29%, p=0.0003) and were drained earlier than PP-FCs (35 [17-69] vs 70 [40-200] days, p=0.0004), more frequently adopting DPPSs rather than LAMSs. Step-up (including necrosectomy) was significantly less frequent (20% vs 51%, p=0.002). Technical (100%) and Clinical success (95% vs 93%, p=0.9) were similar, whilst Adverse Events were lower in the PS-FCs (17% vs 40%, p=0.02), and no recurrence was registered (versus 7.5% in the PP group).

Conclusions: PS-FCs occur earlier, are more often infected, but display simpler morphology, are more suitable for DPPS drainage, and carry a lower risk of step-up, adverse events, and recurrence.

Background and aims: Gastric outlet obstruction (GOO) is a late complication of several malignancies, markedly impairing quality of life. Surgical gastroenterostomy (S-GE) has long been the palliative standard, but outcomes are variable and morbidity remains considerable. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative. We conducted a systematic review and meta-analysis comparing EUS-GE and S-GE, with a specific focus on malignant GOO.

Methods: MEDLINE, Embase, Scopus, and the Cochrane Library were searched through September 2025. Eligible studies directly compared EUS-GE and S-GE and reported clinical success (CS), adverse events (AEs), severe AEs, and recurrence/reintervention. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects models.

Results: Thirteen studies (2 RCTs, 11 retrospective; 1,611 patients) were analyzed. Overall, EUS-GE achieved higher CS (OR 2.69; p=0.007), fewer AEs (OR 0.21; p<0.001) and severe AEs (OR 0.54; p=0.05) versus S-GE, with no significant difference in recurrence/reintervention rate (OR 0.54; p=0.22). In malignant GOO, CS (OR 1.90; p=0.12) and recurrence/reintervention rate (OR 0.68; p=0.50) were comparable, while overall AEs remained lower with EUS-GE (OR 0.26; p<0.01).

Conclusions: In malignant GOO, EUS-GE provides comparable clinical efficacy to S-GE with fewer overall AEs. These data support EUS-GE as a preferred minimally invasive option in selected patients.